Key result
MASLD is linked to a ~159% higher risk of MACE.
Why the study?
Does the presence of MASLD, along with CCTA-detected high-risk plaque characteristics and coronary inflammation, predict major adverse cardiovascular events in patients undergoing CCTA?
Cohort (n=1,966)
Yes
Does the presence of MASLD, along with CCTA-detected high-risk plaque characteristics and coronary inflammation, predict major adverse cardiovascular events in patients undergoing CCTA?
Hazard Ratio: 2.59 (95% CI 1.97–3.42)
Absolute Event Rate: 26.1% vs 9.1%
p-value: p=<0.001
In patients undergoing CCTA, MASLD is associated with a significantly higher risk of MACE, which is partially mediated by increased coronary inflammation and vulnerable plaque burden, highlighting the value of integrating these CCTA markers for risk stratification.
MASLD may flag higher-risk CCTA features; leaves open causal links and need for prospective outcome trials.
Metabolic dysfunction-associated steatotic liver disease (MASLD) correlates with cardiovascular events. We sought to assess the association of coronary computed tomographic angiography (CCTA)-detected high-risk plaque characteristics (HRPC) and coronary inflammation with MASLD and their prognostic implications. This retrospective study comprised two independent cohorts: the internal cohort enrolled eligible participants undergoing both CCTA and abdominal CT within 3 months. Low-attenuation plaque burden (LAPB) and fat attenuation index (FAI) were assessed via CCTA. MASLD was defined by hepatic steatosis plus ≥ 1 cardiometabolic risk factor. This cohort analyzed MASLD associations with plaque characteristics and clinical outcomes, while the external cohort validated the results. Major adverse cardiovascular events (MACE) included cardiovascular death, nonfatal myocardial infarction, stroke, and unstable angina hospitalization. The internal cohort comprised 1,966 patients, with 640 (32.6%) diagnosed with MASLD. Over median 7-year follow-up, MASLD patients had significantly higher MACE rates versus non-MASLD (26.1% vs. 9.1%; P < 0.001), partially associated with LAPB (mediation effect 53.8%) and FAI (mediation effect 44.4%). MASLD patients with LAPB > 4% (35.8%; P < 0.001) or elevated FAI (41.9%; P < 0.001) manifested significantly elevated MACE risk post-adjustment for traditional risk factors. In the 373-patient external cohort with MASLD, FAI and LAPB retained robust prognostic performance; their integration with clinical factors yielded superior risk stratification (C-index 0.76 vs. 0.63; net reclassification index = 0.74, P < 0.001). MASLD patients exhibited poorer cardiovascular outcomes, which is statistically linked in part to greater coronary inflammation and vulnerable plaques. Integrating these markers enhanced prognostic value for risk stratification.
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Zhang et al. (2026) conducted a cohort in Metabolic dysfunction-associated steatotic liver disease (MASLD) (n=1,966). Metabolic dysfunction-associated steatotic liver disease (MASLD) vs. Without MASLD was evaluated on Major adverse cardiovascular events (MACE), defined as a composite of cardiac death, non-fatal myocardial infarction, stroke, and hospitalization for unstable angina (HR 2.59, 95% CI 1.97-3.42, p=<0.001). Metabolic dysfunction-associated steatotic liver disease significantly increased the risk of major adverse cardiovascular events compared to no MASLD (26.1% vs. 9.1%; adjusted HR 2.59).
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